How to Complete Referral Forms

Provider Instructions For Completing The Referral Form For Healthy Start

For translation help, or help in locating substance abuse treatment, call the Family Healthy Line 1-800-451-2229.

1. Complete form by filling in ALL relevant information and checking ALL that applies to patient.
2. The form is to be signed and dated by the person referring the patient, the patient or parent/guardian of patient.

Mail completed forms to:

Healthy Start Risk Screening
Broward County Health Department
2421 SW 6th Avenue
Fort Lauderdale, FL 33315-2613

For Referral Forms, please contact Broward Healthy Start Coalition, Inc. at 954-563-7583